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目的为膝周围恶性肿瘤保留肢体寻求更好的治疗方法和较理想的效果。方法1989年1月~2001年12月对42例膝周围恶性肿瘤行保肢手术治疗,37例获随访。其中男19例,女18例。年龄12~46岁。经病理检查证实为骨肉瘤11例,滑膜肉瘤4例,恶性纤维组织细胞瘤3例,骨巨细胞瘤19例。除骨巨细胞瘤外,余18例术前均行1~2个疗程的新辅助化疗。行假体置换术、异体骨块移植术、骨水泥阿霉素充填术等,术后辅以化疗。术后参照Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准进行评价。结果37例获随访3~11年,平均5.6年。2例分别于术后3、4年肿瘤复发远处转移死亡;1例因肿瘤局部复发而行截肢术;1例因术前放疗,保肢术后伤口发生坏死并感染而行截肢术;2例对异体大块骨移植产生排斥反应致伤口窦道形成而行截肢手术。31例伤口愈合良好,按Enneking肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准进行评定,优7例,良14例,中10例,差6例。结论膝周围恶性肿瘤的早期诊断、手术适应证的掌握、手术方法的选择以及手术前后的化疗或放疗是达到理想疗效的关键。
The purpose of preserving limbs around the knee to seek better treatment of malignant tumors and more satisfactory results. Methods From January 1989 to December 2001, 42 cases of limb salvage surgery were performed on malignant tumors of the knee, and 37 cases were followed up. There were 19 males and 18 females. Age 12 to 46 years old. Pathological examination confirmed osteosarcoma in 11 cases, synovial sarcoma in 4 cases, 3 cases of malignant fibrous histiocytoma, 19 cases of giant cell tumor of bone. In addition to giant cell tumor of bone, the remaining 18 cases were preoperative 1 to 2 courses of neoadjuvant chemotherapy. Prosthesis replacement surgery, allograft bone graft, bone cement doxorubicin filling, postoperative adjuvant chemotherapy. The postoperative evaluation of Enneking limb musculoskeletal tumor surgical evaluation of functional criteria after surgery. Results 37 cases were followed up for 3 to 11 years, an average of 5.6 years. 2 cases died of recurrence of distant metastasis 3 to 4 years after operation, 1 case of amputation due to local tumor recurrence, 1 case of amputation due to preoperative radiotherapy, wound necrosis after limb salvage and infection. 2 Cases of allogeneic large bone graft rejection caused by the formation of the wound sinus amputation surgery. Thirty-one wounds healed well, and were evaluated according to the functional assessment criteria after surgical reconstruction and reconstruction of Enneking limb musculoskeletal tumor. There were 7 cases were excellent, 14 were good, 10 were fair and 6 were poor. Conclusions Early diagnosis of malignant tumors around the knee, mastery of surgical indications, selection of surgical methods and chemotherapy or radiotherapy before and after surgery are the keys to achieve the desired effect.